Are you thinking about starting a group practice? What are some of the behind-the-scenes nuts and bolts that go into starting a group practice? How can you deal with some of the challenges you might face along the way?
In this podcast episode, Joe Sanok speaks to Christine Carville about starting a group practice and having 30 clinicians a year later.
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Meet Christine Carville
Christine Carville, LCSW-R, is the co-founder and C.E.O. of Resilience Lab, an innovative group practice with 30 clinicians providing simple, personalized, affordable therapy in New York. She brings a unique perspective to the mental health industry by combining her expertise as a Columbia School of Social Work professor, her entrepreneurial past, 10 years running multi-disciplinary community-based clinical teams, and her private psychotherapy practice.
Reach out to Christine at [email protected]
In This Podcast
- Things to think about when starting a group practice
- Attracting clinicians
- The behind-the-scenes nuts & bolts
- Resilience Lab during the lockdown
- Moving forward
Things to think about when starting a group practice
- Are you wanting to be a fairly silent owner or do you want to be pretty active?
- Do you want to create systems that work without you or do you want to be hands-on?
The model allows for each of the stakeholders, whether it’s the therapists, whether it’s the supervisors, and even the clients, to be able to spend the most amount of time doing what they’re doing best… interacting with each other. And so that’s what attracted the clinicians and the supervisors.
A lot of clinicians are looking for a way to maximize the time they have to provide the service and not have to do all of the things that go into running the business.
The behind-the-scenes nuts & bolts
It took Christine about a year to come up with the name/business entity/brand. She chose “Resilience” because it’s something that they all have and, working together, they develop individual resilience clans, between client and therapist. It conveyed the best message.
After this, they started organizing the brand around the many legal and policy hurdles state by state which was fairly complicated as they were combining different professions. The idea was to create independence among their professionals, to foster and engender a sense of independence and competence among each of them but provide them with the greatest amount of support and availability for consultation.
Resilience Lab during the lockdown
What was previously one of the hurdles of hiring, ended up becoming a strength. Most of the clinicians had gotten over their trepidation and fear of the unknown, within the therapy room with their clients, just a few months ago. And so now, within a week, they migrated to 100% telehealth. Listening to other practices and other clinicians, it was a much easier transition for the clinicians because they still were getting their sea legs and feeling very capable in that newness, so the transition to Zoom and Google Hangouts was seamless. They hold a weekly Town Hall, for all the clinicians to get together and will continue that after the pandemic as it was a great way for everybody to come together and talk through their challenges.
One great thing that has come from the pandemic is that policymakers have worked quickly to make necessary adjustments. There will be many great new policies allowing for telehealth to move forward and opening up to providing greater access to insurance companies. Resilience Lab’s clients are finding this to be a wonderful addition and they have added support groups where people are coming together and forming online communities.
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Meet Joe Sanok
Joe Sanok helps counselors to create thriving practices that are the envy of other counselors. He has helped counselors to grow their businesses by 50-500% and is proud of all the private practice owners that are growing their income, influence, and impact on the world. Click here to explore consulting with Joe.
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This is the Practice of the Practice podcast with Joe Sanok, session number 466.
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Boy as we get closer and closer to episode 500, I’m thinking, what should I do for episode 500? I feel like I really need to like plan something out. So, we’ll see if we’ll get something for episode 500, I’m sure we’ll figure something out. I’ll let you know if you’re going to be a part of it, because you need to know if you’re going to be a part of it.
You know, today, we’re gonna be talking about starting a group practice. And, you know, when I started my counseling group practice, we got up to 11 clinicians, and I realized I didn’t really want to manage that many people. And I didn’t really want to hire a practice manager. And at that point, Practice of the Practice was really starting to take off. And so, I think part of having a group practice is figuring out what do you want to put into it? Do you want to be a fairly silent owner? Do you want to be pretty active? Do you want to create systems and have it just kind of rock out without you? Or do you want to be hands-on? I hear some people talk about, oh, I want my practice to feel like a family and have this culture and that’s great. For me, I didn’t want that. I wanted to have a place where people could come after they worked at their nonprofit or that they could transition into full time practice; they could show up, they could do the work, they could feel supported and they could go home to their families and make good money. We were nice to each other, but it wasn’t like it was gonna be this huge family that we were connecting with. And so, understanding what you want in your practice is so important. And I really want you to think through that, as we hear Christine talk about how she started a group practice a year ago, and now has over 30 clinicians. So, without any further ado, here’s Christine.
Well, today on the Practice of the Practice podcast, we have Christine Carville. Christine is the co-founder and CEO of Resilience Lab, an innovative group practice with 30 clinicians, providing simple, personalized, affordable therapy in New York. Christine, welcome to the Practice of the Practice podcast.
It’s great to be here. Thank you, Joe.
Yeah. I’m really excited because whenever I can get a group practice owner on, I think it helps people think through their solo practice and to also feel like, you know what, I can do this. And I’d love to just start with, when did you start the group practice, and what were some of maybe the major pillars or stepping stones of that development?
Well, I had a couple of phases. So, I think in this final version, that we began in July of last year, in 2019, so it’s almost been a year. And it began as an experiment. I had been in private practice, a solo practice, previously. I also was running a program called an ACT Team, which is for people with severe and persistent mental illness. And I was very discouraged by how the resources were being used in the public healthcare system. And I really wanted to form what… I was learning about a social enterprise, so bringing the best of the private practice and private resource funding, with the efficiency that we could have, to the idea that I would be making the greatest social impact. And so, I was looking for a model of how I could bring those two things together.
In the meantime, during my private practice, I met a woman who had founded an innovative company, a matchmaking service called MyWellbeing. And what they did was they matched… what they continue to do is they match therapy seekers with therapists in the New York City area. And so, I found it to be incredibly efficient and helpful and the platform provides a lot of education for therapy seekers. And so we started to work together in terms of how to create a model where we would bring newer clinicians together to educate and support them, providing lots of clinical supervision and oversight for their growing practice, in order to be able to match to as many clients as possible. This we just started as an experiment and had not incorporated or created an actual business background for it. And it became so popular, so many clinicians were coming on board, that I needed to find a way to scale it so that we had multiple supervisors and we were really using the resources correctly. So, over the months, it seemed that my model for social enterprise was beginning to evolve and to develop itself.
Yeah, and how are you attracting so many clinicians to partner with you and to join you? Because, you know, most people a year into group practice, they might have two or three people. How are you able to really attract that much talent?
Well, so what we hear – I have to say I’ve interviewed now hundreds of clinicians of various levels of experience, and I’d have to say that what I hear the most often is, I did not get into this industry to run a company or run a business, and I got into this to help people. And what we’ve been finding is that people are, clinicians are, looking for a way to be able to maximize the amount of time they have to provide the service, not to do the paperwork, not to set up the business entities, not to do the accounting or the branding, or all of the things that go into running the business. And so, the model allows for each of the stakeholders, whether it’s the therapists, whether it’s the supervisors, and even the clients to be able to spend the most amount of time doing what they’re doing best, interacting with each other. And so that’s what attracted the clinicians and the supervisors.
And what are some of the behind the scenes kind of nuts and bolts to allow that because I think people hear that and think that sounds great. Yeah, I don’t want to do all that stuff. What on the back end did you have to develop over the last year?
So, the business entity, the brand. It took me about a year to come up with, what was the name that I wanted to convey? And for us, we chose resilience because it’s something that all of us have, but varying degrees of investigation and working together, we develop individual resilience plans, between the client and the therapists. And so, I thought that that conveyed the best message. And so, we just started to organize the brand around that. As I’m sure you’re aware, there’s just so many legal and policy hurdles to jump through, state by state, setting up a mental health practice. And so, we needed to figure out and navigate those. We have multiple professions, so not just LMS and LCSW’s, but also psychologists in our practice and so it was fairly complicated when you’re combining different professions. And so, we figured that out. We have a team of four lawyers and several accountants who are working together to do those things. And so, we just got to the business of setting that up. And then the idea is that we want to create a lot of independence among our professionals. So, all of our team, clinician supervisors, everybody is a professional. And so, we want to foster and engender that sense of independence and competence among each of them but provide them with the greatest amount of support and availability for consultation from us if they need it.
Wow. So, when you think about kind of after the setup, and after things kind of got rolling, what were some challenges early on that you had to address?
Well, there were challenges at every level. So, the legal and policy challenges, just setting up the business, was fairly complicated. But once that’s done, that’s in place; that took probably two or three months, and trademarking across the country and in different states. Then it was, I would say hiring the clinicians. So, the idea of the model is we’re able to offer more affordable private practice therapy because we’re hiring newer, fresher clinicians out of school. Typically, a group practice is not looking to hire a clinician without at least one or two years of experience because of the turnover with clients, and there’s probably about a three-month horizon where the clinicians are getting their bearings and their footing. And so, a lot of group practices aren’t set up to have that sort of turnover financially. And so that is part of our model, that we expect that, we anticipate that, and we support that as the clinicians are getting their voice as clinicians. And so being able to communicate this to a newer clinician, when we’re looking to hire, we’re looking for people who are okay with making mistakes, who are okay with the uncertainty and the bravery that it takes to sit with a client when you don’t necessarily feel like you’ve had enough training yet. What I told all the clinicians when we were first hiring is – I teach at Columbia, the advanced clinical practice class and so I’ve been working with new graduates for years, and I hear, oh, I don’t know enough to begin work and what I tell all the new clinicians is, you have the skills that you need to begin working with clients and making a big impact and we just need to continue the learning for years to come, but you have what you need right now to meet with the clients.
Oh, that’s awesome.
So that was one of the biggest challenges, yes. Yeah.
And then as you… right now we’re in the midst of, you know, this pandemic lockdown. At the time of this recording it’s April and this will go live in June. How has that affected the business? How did you guys navigate during lockdown? New York’s been hit really, really hard. Talk a little bit about what the business looked like through this phase of our nation’s unique history.
Well, yes, so it came upon us as I’m sure it came upon most people listening, seemed like a tidal wave and seemingly out of nowhere, even though we had heard about it for weeks and weeks. And I think what we were previously talking about being one of the hurdles of hiring ended up becoming a strength in this, because most of the clinicians had gotten over their trepidation and their sort of fear of the unknown within the therapy room with their clients just a few months ago. And so now we migrated within a week to 100% telehealth. And from what I was understanding, listening to other practices and other clinicians, it was a much easier transition for our clinicians because they still were getting their sea legs and feeling very capable in that newness, and so the transition to Zoom and to Google Hangouts, which is what we’ve been using, was, I would say, seamless. We hold a weekly town hall for all the clinicians to get together. And we probably will continue that through from now on, even once the confinement’s over, just because it was a great way for everybody to come together and talk through whatever fears they’re having, challenges. What we were hearing the most is that the telehealth sessions are much more intense and exhausting than in-person sessions. But otherwise, everybody was fairly surprised by how much can be transmitted and done in these sessions. So, I think it’s been a surprising experience for us.
Yeah, and when you kind of look forward in regards to ongoing marketing or how you’re going to pivot as a result of this, what kind of things are you considering moving forward?
Well, I do believe one of the great things that has come from this is, in my 15 years in this field, I have not seen policymakers and the bureaucracy work as quickly as they have to adjust to this. And so, I believe there will be many great new policies allowing for telehealth moving forward and opening up to providing greater access with insurance companies and things like that. So, we’re very encouraged by what we’re seeing on that front, and we don’t think it’ll change back. Our clients are finding this to be a wonderful addition, we’ve added a bunch of support groups and people are coming together, forming communities online, which we will continue to probably use as well. So I think that what this has done is when we return to our offices, in whatever capacity we’ll be able to do, looking to do it maybe in May or June, we will also be keeping what we have found in the community building, both among our clinicians in our offices, but also within our clients – we’ll probably keep those in place.
Yeah, so if there was someone that, say right now, was saying I want to plan to start a group practice, what would be things you think that they should consider, that they should sort through? Maybe three to five bullet points of, these are kind of your first steps when you’re thinking about a group practice.
So, because my practice happened as an accident, I was supporting myself from my own private practice and I did not mix the two. I was looking at this as an intellectual exercise; it was about seeing what worked and allowing for the model and the practice itself to emerge naturally, to see what worked. And so, had I been relying on the group practice from the beginning for my income, I think it would have been a much different experience, both in how I was hiring and how I was looking at office space. And so, from my own experience, I would suggest doing that just so that you are creating a business that was emerging for the health of the business rather than from the daily needs that you might have income-wise.
Yeah, that’s, that’s great. And what else would you say people should sort through in regards to steps and considerations, and finding the best people, and positioning yourself with marketing, all those things that go into starting a group practice?
Well, I’m sure the group practice prospective owners will be listening to a bunch of podcasts like your own, like I did. And one of the best, I think, recommendations among each of the podcasters are that you develop your brand and know your mission and have that be consistent with all of the dimensions of your business. So, the hiring and fee setting and the brand message. So, I think that those threads remaining consistent, help you make the decisions that you’re confronted with every day. So, in that, who you’re hiring, both to do the branding work or the technical work that you’ll need, as well as the clinicians that will be representing and working with your clients.
Awesome. And Christine, the last question I always ask is, if every private practitioner in the world were listening right now, what would you want them to know?
That if you’re considering leaving a job in an agency that you’re not thrilled about, but you’re worried about leaving too soon, I say it’s not soon enough. Leave; there’s so much opportunity to build a thriving, enriching practice and to make your mark.
That’s so awesome. And Christine, if people want to connect with you and your work, what’s the best way for them to connect with you?
The best way is probably email: [email protected] and I encourage anybody to.
Awesome Well, thank you so much for being on the Practice of the Practice podcast.
Thank you so much, Joe.
I am blown away by people like Christine that really take the information they’ve received from Practice of the Practice, from other websites, from all these great consultants that are out there; people like Gordon Brewer or Jessica Tappana, or ZinnyMe or John Clarke, all these really great people that are doing consulting, and they kind of gather all that information, and then they put it into action. I just love to see that. And Christine, really, I think, has done that with her practice.
So also special thanks to TherapyNotes. TherapyNotes is the premier electronic health records. So many of our Next Level Practice members use them and love how they’ve added the telehealth platform to it as well. TherapyNotes really is a great company, they’re solid. They’re someone who’s been a sponsor for a number of yours and we fully recommend them as the electronic health record to use. You can go over to therapynotes.com and use promo code JOE to get two months for free. And if you actually want six months for free, when you’re a Next Level Practice member, you can get six months for free. We’re going to be opening up Next Level Practice in August again, and we’re only opening it a couple times a year so that our cohorts can really get to know each other. And that’s a limited number of people, and we’ll talk a little bit more about what Next Level Practice is and why it’s something that’s really gonna be helpful for you. But if you want to be on that list, head on over to practiceofthepractice.com/invite and you’ll get the invite and all the information about Next Level Practice so that when that date comes in late August that you will be able to jump in. Thanks so much for letting me into your ears and into your brain. Have a great day.
Special thanks to the band Silence is Sexy for your intro music. We really like it. This podcast is designed to provide accurate, authoritative information in regard to the subject matter covered. It is given with the understanding that neither the host, the publisher, or the guests are rendering legal, accounting, clinical or other professional information. If you want a professional, you should find one.